Abstract
OBJECTIVES: To determine the feasibility of pragmatic implementation strategies for three good questions (in Dutch: Drie Goede Vragen; 3GV. What are my options; what are the risks and benefits related to these options; and what does this mean for my situation?) to increase shared decision-making (SDM) efforts in Dutch secondary care, and identify barriers and facilitators of implementation. METHODS: Convergent mixed-method design: pre-post surveys with patients attending one of six clinical departments in a Dutch Hospital, post-intervention interviews with patients and health-care professionals. Primary outcomes: feasibility (reach, use of 3GV). SECONDARY OUTCOMES: SDM, experiences with 3GV and decision making. Interviews focused on barriers and facilitators of 3GV use. Interviews were content coded and categorized into determinants of behaviour change. RESULTS: 35% of the respondents who had heard of 3GV (52%) used all three questions. 3GV use did not lead to more SDM (SDMQ9 M = Δ0.3;SE = 2.2) but patients felt empowered to decide (88%) and to SDM (86%). Barriers were as follows: time investment, other SDM projects and perception that the need to use 3GV differs per patient/consultation. Respondents preferred to use 3GV as they saw fit for the consultation, instead of literally asking them. Facilitators: easy, accessible information materials that can be flexibly used. CONCLUSION: Implementation of 3GV seemed feasible, although influenced by contextual characteristics (eg type of decisions, patients, on-going interventions). 3GV contributed to important elements of SDM, and respondents were willing to apply them in a way that suited their situation. PRACTICE IMPLICATIONS: We recommend continuation of current and new implementation strategies to enable 3GV implementation in secondary care.